| NPI | 1740267145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD - 7199) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: HI 7199) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2013-05-07 |